Provider Demographics
NPI:1730900267
Name:HAYNES, ASHLEE M
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:M
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MENKE CIR STE 63015
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4632
Mailing Address - Country:US
Mailing Address - Phone:402-212-7765
Mailing Address - Fax:
Practice Address - Street 1:3015 MENKE CIR STE 63015
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4632
Practice Address - Country:US
Practice Address - Phone:402-212-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6173888251E00000X, 374U00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide